European Neurological Review, the peer-reviewed journal, has published the proceedings of a satellite symposium held at the first annual congress of the EAN in Berlin in June highlighting the need to look beyond the clinical study data when seeking optimal therapies in individual patients with epilepsy.

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There is now an extensive range of anti-epileptic drugs (AEDs) available including older established treatments and a newer generation of medications. The choice of drugs and what constitutes optimal therapy, however, is unclear due to limitations in the data supporting their use, particularly among the newer treatments. In clinical trials of monotherapy, a treatment is required to show only non-inferiority to another benchmark treatment. In trials of polytherapy, comparisons are limited to placebo. It is therefore necessary to look beyond the study data and consider other parameters to ascertain the most suitable treatment for the individual patient. Available evidence suggests that efficacy is similar among most AEDs, but this does not mean they are all the same. Some show efficacy in early and refractory epilepsy and some improve depression and quality of life (QOL) in epilepsy. AEDs are associated with a range of adverse events (AEs) that can limit their usefulness. AE classifications include type A (augmented and dose related) including tiredness, fatigue, insomnia, dizziness, vertigo, imbalance, ataxia, tremor and cognitive impairment; type B (bizarre and idiosyncratic) including various hypersensitivity reactions; type C (chronic long-term toxicity) including hirsutism, alopecia, weight gain and obesity; and type D (teratogenesis and carcinogenesis). The newer AEDs have been more thoroughly assessed for AEs than older drugs and risks are better understood. In AED safety, it is not better to follow a policy of 'better the devil you know' but rather to carefully monitor AE incidence and be prepared to switch drugs to improve tolerability and avoid non-compliance and treatment failure.

touchNEUROLOGY (a division of Touch Medical Media) publishesEuropean Neurological Review, a peer-reviewed, open access, bi-annual journal specialising in the publication of balanced and comprehensive review articles written by leading authorities to address the most important and salient developments in the field of neurology. The aim of these reviews is to break down the high science from 'data-rich' primary papers and provide practical advice and opinion on how this information can help physicians in the day to day clinical setting. Practice guidelines, symposium write-ups, case reports, and original research articles are also featured to promote discussion and learning amongst physicians, clinicians, researchers and related healthcare professionals.